Re: case of discussion

[palak mehta]

Dear Dr Sitaram,

In c/o Ca larynx with extension in neck You can do repeated Glossopharyngeal nerve block or RF procedures of GPN. You can also go for Stellate Ganglion block diagnostic f/b therapeutic block or RF procedure.

Brufen would not be of much help in this case . you can give morphine 30 mg qid. For break through pain you can give Butrum nasal spray or OTFC ( Fentanyl Lollipop). You can add some adjunvents like Tryptomer, Anticonvulsant.

Thanks and Regards 

 

Dr Palak Mehta, MD, FIPM, FIPP
Director: Pain Care Clinic, Ahmedabad.
Visiting Faculty and Consultant : Daradia Pain Clinic, Kolkata.
For Details Visit: www.paincareclinic.in
For more queries: in...@paincareclinic.in

For Appointment: 09408754678

Mobile: 09825347957

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From: seetaram korgaonkar <svk...@gmail.com>
To: palak mehta <pbm...@yahoo.co.in>
Sent: Wednesday, 21 March 2012 11:42 PM
Subject: case of discussion

Dear madam Palak,

I have a patient who is 60 years old.Operated for Ca larynx in 2010, laryLaser ngectomy done with node dissection followed by RT.Patient has recurrence now.Fungating growth on left side of neck extendind up to lat side of left neck.Patient is having excruciating pain in region of growth.Pain is radiating up to L ear and parietal bone area part of occiput and L shoulder ie in C2,C3,C4 area.Pain is burning in nature.

Difficulty in swallowing liquid.

H/o constipation +

There is no s/o brachial plexus involment.

Patint is on Morphin tab 20mg 4hly,Fentanyl patch 50mcg/hr,Brufen 400mgs.He is not pain free VAS is 10,After morpine tab VAS comes to 5 but after 3hr it becomes 10.Plus he gets Breakthrough pain in between.

All vital parameters are normal,Lab tests are normal.

Due to big fungating mass no proper approach to do Cervical plexus intervention,superficial or Deep.

 

Pl suggest me any other way to pain management in this patient.

 

Dr.seetaram Korgaokar

Goa